Budd-Chiari综合征介入治疗的临床疗效评价

目的 评价不同类型Budd-Chiari综合征(BCS)介入治疗的临床疗效.方法 回顾性分析159例经超声和选择性静脉造影确诊的BCS患者的临床资料,对其中147例资料完整者进行临床疗效评价.根据新的影像学分型,147例患者中,13.6/(20例)为单纯肝静脉阻塞型,66.0/(97例)为下腔静脉膜性阻寨型,6.1/(9例)为下腔静脉膜性闭塞伴远端腔内巨大血栓形成型,14.3/(21例)为下腔静脉节段性阻塞型.根据病变类型分别对147例BCS患者进行了介入治疗,包括经导管局部溶栓术、经皮腔内血管成形术(PTA)、血管内支架置入术和改良式经皮经肝门体静脉分流术(MTIPS)等.术中根据静脉造影图像判断肝静脉回流改善情况.对147例患者平均随访了(67.3±9.0)个月(16 h至104个月),随访内容包括忠者的症状、体征、肝功能检查结果和超声检查结果,评价介入治疗的首次开通率与再次治疗开通率,同时对所有患者的肝功能水平进行Child-Push评分与分级.术前与末次随访评分差异用配对样本均数t检验进行统计学评估.结果 PTA的首次治疗开通率为65.6/(86/131),再次治疗开通率为96.9/(124/128).血管内支架置入术的首次开通率为78.9/(15/19),再次开通率为92.3/(24/26).Ⅰ例Ⅲa型BCS患者在下腔静脉开通后72 h死于不明原因的咯血、1例Ⅰ b型BCS患者MTIPS术后16 h死于弥漫性血管内凝血、Ⅰ例Ⅳ b型BCS患者在接受MTIPS术后13个月死于肝功能衰竭.另有12例患者分别在术后7～79个月死于与介入治疗无关的其他原因.末次随访,存活患者肝功能明显改善,平均Child-Push评分由术前的8分降低至5分(t=2.017,P＜0.05).结论 应用多种血管介入技术治疗BCS可获得满意的临床疗效.

Oinieal evaluation of interventional treatment for Budd-Chiari syndrome

Objective To evaluate the interventional treatment of Budd-Chiari syndrome (BCS)with regard to different types of the disease.Methods One hundred and fifty-nine consecutive cases with BCS underwent interventional treatments with regard to different types of the diseases,including percutaneous angioplasty (PTA),transcatheter thrombolysis,endovascular stent implantation and modified transjugular intrahepatic portosystemic shunt(MTIPS).Among them,147 cases that underwent complete follow-up were enrolled in this study.Simple obstruction of HV,membranous obstruction of IVC,membranous obstruction of IVC combined with thrombosis in the distal lumen and segmental obstruction of IVC constituted 13.6/(20),66.0/(97),6.1/(9)and 14.3/(21/147),respectively.The technical success rate of each type Was determined.They were followed up for(67.3±9.0)months (16 h-104 months).Overall primary patency rote was evaluated.The late effect on liver function Was analyzed according to the Child-Push score.Results The primary patency rate of PTA was 65.6/ (86/131)and the secondary pateney rate was 96.9/(124/128).The primary patency rate of stent implantation was 78.9/(15/19)and the secondary patency rate Was 92.3/(24/26).One patient of type Ⅲa that received recanalization,catheter-directed thrombolysis and PTA in IVC died of hemoptysis 72 h after the procedtire.One patients of type I b who received MTIPS died of DIC 16 hrs after the procedure.And one patient of type Ⅳb who received MTIPS died of hver failure 13 months after the procedure.Twelve patients died in 7-79 months after the interventional procedure due to unrelated causes.At the end of follow-up,the liver function of the patients Was improved. Conclusions Optimal application of various vascular interventional techniques has a satisfactory primary and secondary patency rate and improves the long-term liver function.